Methodist Hospital Pathology Center – Schenken Pavillion

Brenda Ronspies and Sasan Gholami, MD

From a simple blood draw to antigen testing that saved Brenda’s life – pathology is an often unknown component of patient care.

Sometimes, a diagnosis can be complicated. When the care team is searching for answers they often turn to the team of scientists at the Methodist Hospital Pathology Center – Schenken Pavilion for the answers they seek.

Methodist Pathology Center helps with lifesaving diagnosis

Brenda Ronspies was a 44-year-old woman enjoying life and time with her 20-month-old son. But in March she woke up not feeling like herself. With every breath came pain that soon moved down her arm. She was certain it was a heart attack.

A trip to the emergency department (ED) resulted in an initial diagnosis of pleurisy. With medication in hand, Brenda headed home with the hope of feeling better – soon. But that was not the case. By day three, breathing became excruciatingly painful, and another trip to the ED was necessary.

“I was admitted, and further testing determined I had pneumonia,” Brenda said. “The medical team began giving me antibiotics, but the treatment wasn’t working. The doctors weren’t sure what was happening. The medical staff ended up putting me in a medically-induced coma, which paralyzed me from the waist down. Those overseeing my care told my family they didn’t know if I would make it through the night.”

"It was honestly very touch and go for Brenda until we were able to determine what was attacking her system.”

Sasan Gholami, MD

It was all hands on deck for Brenda’s case. Sasan Gholami, MD, an infectious disease specialist at Methodist Physicians Clinic Regency, was among those called to the table.
“I was involved in Brenda’s care from the beginning. It was puzzling to try and figure out what was making someone so young and previously healthy suddenly so critically ill,” Dr. Gholami said. “We began running tests – we did a bronchoscopy to rule out cancer, we did staining for fungal organisms and multiple cultures – all of which were tested and reviewed by our pathology team. The final diagnosis of pneumococcal pneumonia was based on an antigen test. It was honestly very touch and go for Brenda until we were able to determine what was attacking her system.”

Dr. Gholami noted that Brenda’s pneumonia led to sepsis, and eventually ARDS (Adult Respiratory Distress Syndrome). ARDS is respiratory failure that develops sometimes in critically ill patients from lung injury and increased vascular permeability.
Brenda remained in a coma for 30 days, with medications administered during that time, which helped her heal. Slowly, she was brought out of her induced state, continuing to heal on a ventilator and with a tracheotomy.

Pathologists are infection detectives

What is making someone ill can be complicated, and at the very root of the patient’s health issue could very well be an infection. From a wound that’s gone bad to bacteria attacking a person’s system, determining what the organism is and how to effectively treat it becomes essential.

That’s the role of a microbiologist. Anything that comes out of you or off of you, these folks can test it. When dealing with infections, cultures have to grow. What evolves during that time period becomes the tool to identification.
With the help of incubators, Petri dishes of specimens grow for 16 to 24 hours. The sometimes colorful results can be good or bad news for Methodist patients.

“When someone has something wrong with them, they don’t know what it is,” said Carrie Kriener, microbiologist. “To be able to tell them what it is and what antibiotic will treat it is a relief for them. It makes us feel good because we have given an answer and there is no more uncertainty. Whether it’s an infection or cancer, they have an answer, and for many that fear, panic and helplessness go away.”

Pathologists work behind the scenes

Pathology, in the simplest of terms, is the study and diagnosis of disease and a patient’s general health. But what happens on a daily basis is anything but simple.

“A patient’s diagnosis or the development of a treatment plan based on our findings is essential to the patient care continuum,” said Laura Brock, service executive and leader of The Pathology Center. “Our team provides findings in a timely fashion to the surgeon, physician or others on the care team. Whether it’s confirming a patient’s diagnosis, therapy or their health status, we are at the core of the patient’s health care journey.”

The Pathology Center’s experts include pathologists, medical technologists, cytotechnologists, histotechnicians, histotechnologists, cytogenetic technologists and phlebotomists. All specialties require some degree of additional training to gain the skills and knowledge necessary to hone their craft.

“The skill level of these individuals is tremendous,” Brock said. “Our pathologists have all earned their medical degrees and have sub-specialties in specific areas of pathology. Most other positions within our department require at least a one-year internship beyond a bachelor’s degree. Our nearly 200 laboratory professionals enjoy their profession, and it shows in the work they do each and every day.”

Pathologists assist with diagnosis

Michael Mann, pathology assistant, spends his day looking at prostates, breasts, lobes of lungs, placentas and uteri, all of which have been surgically removed from patients who may be facing a cancer diagnosis. With a scalpel in hand, Mann prepares to confirm the preliminary findings, which are then handed off to pathologists for final diagnosis.

“We want to see if the tumor is still contained and if the surgeon got the entire tumor,” Mann said. “That is a big question, and we spend a lot of time answering it.”

Mann, and others who specialize in anatomic pathology examine and analyze every tissue – looking for red flags that might signal something more significant, with a focus on cancer indicators.

“We deal with a lot of cancer, which is usually bad news,” he said. “We give a surgeon or oncologist the information they need to treat this really horrible disease the best way they can and to find the best treatment possible. I want to find that cancer as quickly as I can so we can reassure the patient and develop a plan to proceed.”

It’s All About the Cells

While Michael Mann works with big specimens, Amy Wyant and cytotechnologists at The Pathology Center focus on the smallest of health indicators.

Analyzing body fluids obtained from fine needle aspirations (FNAs), pap smears and urine samples is what occupies a cytotechnologist’s day. It is their efforts and expertise which serve as a primary diagnosis and can result in a surgical intervention.

“We’re looking for abnormal cells,” Wyant said. “Malignant cells are ugly and they look unhappy. Tumor cells also tend to have too much DNA. In some cases, malignant cells and benign cells can look very similar. If what we did was straightforward, then we wouldn’t have to be as trained as we are.”
Wyant is joined by four other cytotechnologists who evaluate bronchial specimens, GYN fluids and non-GYN fluids. They can also be called on-site at Methodist Hospital or Methodist Estabrook Cancer Center to assist with FNAs.

“In most situations the lab is at the core of the diagnosis process,” Wyant said. “We play an integral role in health care treatment, and most people don’t know we exist. A bad day for a patient can be a very good day for us – when we are able to provide an accurate diagnosis that helps the physician determine the course of treatment.”

Thankful for their work

Brenda is still feeling the after-effects of her pneumonia battle. Her lungs are scarred, which makes even simple tasks at home difficult to complete. She now knows how perilous her situation was and is grateful for all who played a role in her recovery.

"Whether it’s an infection or cancer, they have an answer, and for many that fear, panic and helplessness go away.”

Carrie Kriener, microbiologist

“I wish I knew everyone who was involved,” Brenda said. “I know that tests were sent to pathology for diagnosis. I had so many doctors and nurses who cared for me. They knew they had to do something – quickly – to save me, and they did. I’ve been told it’s a miracle I’m alive. The care I received at Methodist was outstanding, whether it came from the doctor and nurses who cared for me or the technologist who diagnosed me – I wouldn’t be here today without everyone who played a part in my care.”

Story by Claudia Bohn